Healthcare Provider Details

I. General information

NPI: 1972979508
Provider Name (Legal Business Name): JULIA MONROE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 163, BLDG KA-2010
KAYENTA AZ
86033-0368
US

IV. Provider business mailing address

HIGHWAY 160 M.P. 394.3 BOX 368
KAYENTA AZ
86033-0368
US

V. Phone/Fax

Practice location:
  • Phone: 928-697-4224
  • Fax: 928-697-4030
Mailing address:
  • Phone: 928-697-4129
  • Fax: 928-697-4038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN092746
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN092746
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: